Renal failure and renal dysfunction are frequently presenting complications in patients with cirrhosis or liver failure and is associated with high morbidity and mortality rates. Renal failure is characterised by a rapid deterioration in kidney function and is usually fatal unless a liver transplant is performed, although various treatments, such as dialysis, can prevent advancement of the condition.
Renal dysfunction and renal failure can affect individuals with cirrhosis (regardless of cause), severe alcoholic hepatitis, or fulminant hepatic failure, and usually occurs when liver function deteriorates rapidly because of an acute injury. Renal dysfunction in cirrhosis may be due to superimposed infection and inflammation or in its absence, a situation referred to as hepatorenal syndrome (HRS). These are relatively common complications of cirrhosis, occurring in 18% of cirrhotics within one year of their diagnosis, and in 39% of cirrhotics within five years of their diagnosis.
HRS has been hypothesised to result from changes in the circulation that supplies the intestines, altering blood flow and blood vessel tone in the kidneys. The renal failure of HRS is hypothesised to be a consequence of these changes in blood flow, rather than direct damage to the kidney; the kidneys themselves appear normal to the naked eye and tissue is normal when viewed under the microscope, and the kidneys even function normally when placed in an otherwise healthy environment (such as if transplanted into a person with a healthy liver). However, the situation in patients who develop renal dysfunction in association with superimposed infection or inflammation is often associated with evidence of anatomical renal damage on histopathology.
Brain dysfunction of cirrhosis is often precipitated by infection or inflammation. Studies suggest that brain dysfunction of cirrhosis may not be completely reversible suggesting that there may be death of brain cells in this situation.